Training lay people as first responders to reduce road traffic mortalities and morbidities in Ethiopia: Challenges, barriers and feasible solutions.

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Road traffic accidents (RTAs) have become global public safety and development hindrances, especially in the low and middle income countries, where the rate is significantly higher compared to the industrialized nations. The WHO warns, unless action is taken to improve road safety systems, the number of people killed by car accidents will triple to about thirty six million per year, and "RTA will become the world's third leading cause of premature death by 2020"; overpassing cerebrovascular disease, COPD, diabetes mellitus, premature & low birth weight, neonatal infections, diarrheal disease and even HIV/AIDS and be out ranked only by depression and heart disease". Provided that, one would assume that road traffic accidents, especially in the developing world, would be among the important health burdens worthy of close attention by both international agencies and local governments. But, the effect of trauma and injury, in terms of mortality and long term disability, in the developing countries, is neglected and underfunded due to "emphasis put on malnutrition and communicable diseases". In the absence of outside help, poor countries, especially where the rate is high, need to come up with innovative and cost-effective ways to deal with this rapidly growing burden. In 2004, the WHO published a guideline for interventions designed to train lay people as first responders in trauma situations. The goal of the program is to decrease the likelihood of unnecessary death and injury by minimizing the time elapsed from the onset of the accident to trauma care facility. This program entails contacting and notifying the emergency service and providing facilities about the nature and magnitude of the accident, taking action to secure the scene in order prevent the injured and other onlookers from harm that may be caused by other crashes, organizing people and resources" i.e. divide tasks and delegate people who, manage the crowed (disperse if necessary), confront and console relatives of victims, and those who would apply first aid to the victims and physically transport them to the nearest facility in the absence of ambulance. The initiative has been implemented in some countries such as Ghana, Uganda, Madagascar, Iraq, and India and has proven to be effective. Despite having low vehicle per population density, RTA rates in Ethiopia are rising. Ethiopia is periodically ranked among the countries with the highest per accident death and injury rates. A number of factors contribute to the high number of road traffic accidents in Ethiopia. These factors that can be categorized into 3 main groups: human factors (e.g. disobeying traffic rules), vehicle factors (e.g. driving old and uninspected cars) and environment factors (poor road and other infrastructure conditions, climate and topography etc.). While these are the determinant factors for car accidents in Ethiopia, the factors that lead to high per vehicle cars death and injury in Ethiopia are undeveloped health and emergency care system i.e. inefficient delivery of primary and emergency care, lack of facilities and resources, over loading, lack of adherence to using in vehicle safety equipment, urbanization and high population density. Although the government is working hard to attenuate the problem, it is clear that there is still more that needs to be done. Among the actions the government can take is applying this intervention and train lay people such as onlookers, bystanders, civil servants, police and other traffic coordinators, and taxi, mini- bus and commercial truck drivers. Successful implementation of the process will, however, require removing socio-cultural, economic and political barriers. The barriers identified in this paper are, socio-cultural factors (religion, literacy, lack of confidence by trainees, fear of contracting HIV/AIDS, economic factors (tendency by trainees to charge for their services and thus only help those who can pay), political factors (lack of political commitment by regional and federal government). With these barriers removed, the intervention can contribute to the reduction of per accident mortality and morbidity rate in Ethiopia.